Provider Demographics
NPI:1497865166
Name:MENDOZA AND CHANG LLC
Entity Type:Organization
Organization Name:MENDOZA AND CHANG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-821-6235
Mailing Address - Street 1:3 CLARA HOWARD WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1024
Mailing Address - Country:US
Mailing Address - Phone:508-821-6235
Mailing Address - Fax:
Practice Address - Street 1:3 CLARA HOWARD WAY
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1024
Practice Address - Country:US
Practice Address - Phone:508-821-6235
Practice Address - Fax:508-749-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA616882OtherTUFTS
MA42258OtherHEALTHNET
MAM18797OtherBLUE CROSS
MA9731890Medicaid
MAM18797OtherBLUE CROSS
MADB8362Medicare PIN